Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.94 / $123.48 / $188.88	Facility	26	$82.94	$123.48	$188.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.14 / $59.18 / $207.36	Professional		$50.14	$59.18	$207.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.57 / $32.58 / $117.36	Professional	26	$26.57	$32.58	$117.36
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $53.40 / $136.72 / $163.19	Professional	52	$53.40	$136.72	$163.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.57 / $27.86 / $70.31	Professional	TC	$23.57	$27.86	$70.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $78.91 / $152.69 / $183.46	Professional		$78.91	$152.69	$183.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.17 / $91.88 / $105.18	Professional	26	$43.17	$91.88	$105.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.74 / $60.81 / $84.43	Professional	TC	$35.74	$60.81	$84.43
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $126.95 / $152.34 / $346.34	Professional		$126.95	$152.34	$346.34
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $68.73 / $84.11 / $243.69	Professional	26	$68.73	$84.11	$243.69
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $69.84 / $138.87 / $268.83	Professional	52	$69.84	$138.87	$268.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $55.40 / $69.87 / $165.62	Professional	TC	$55.40	$69.87	$165.62
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $193.75 / $211.95 / $346.43	Professional		$193.75	$211.95	$346.43
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $106.25 / $119.00 / $189.98	Professional	26	$106.25	$119.00	$189.98
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $87.50 / $97.20 / $156.44	Professional	TC	$87.50	$97.20	$156.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $73.63 / $189.60 / $346.43	Professional		$73.63	$189.60	$346.43
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $85.00 / $127.50 / $194.23	Professional	26	$85.00	$127.50	$194.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $70.61 / $105.00 / $158.90	Professional	TC	$70.61	$105.00	$158.90
United Facility/Professional Professional Modifier Low / Median / High Price $83.15 / $141.12 / $220.85	Professional		$83.15	$141.12	$220.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.36 / $84.14 / $131.49	Professional	26	$42.36	$84.14	$131.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.79 / $57.10 / $89.36	Professional	TC	$40.79	$57.10	$89.36